Postoperative malignant hyperthermia confirmed by calcium-induced calcium release rate after breast cancer surgery, in which prompt recognition and immediate dantrolene administration were life-saving: a case report
Abstract Background Malignant hyperthermia (MH) is a rare genetic disease characterized by the development of very serious symptoms, and hence prompt and appropriate treatment is required. However, postoperative MH is very rare, representing only 1.9% of cases as reported in the North American Malig...
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| Format: | Article |
| Language: | English |
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BMC
2021-04-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-021-02681-0 |
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| author | Natsumi Miyazaki Takayuki Kobayashi Takako Komiya Toshio Okada Yusuke Ishida Hidekimi Fukui Yukihiko Ogihara Hiroyuki Uchino |
| author_facet | Natsumi Miyazaki Takayuki Kobayashi Takako Komiya Toshio Okada Yusuke Ishida Hidekimi Fukui Yukihiko Ogihara Hiroyuki Uchino |
| author_sort | Natsumi Miyazaki |
| collection | DOAJ |
| description | Abstract Background Malignant hyperthermia (MH) is a rare genetic disease characterized by the development of very serious symptoms, and hence prompt and appropriate treatment is required. However, postoperative MH is very rare, representing only 1.9% of cases as reported in the North American Malignant Hyperthermia Registry (NAMHR). We report a rare case of a patient who developed sudden postoperative hyperthermia after mastectomy, which was definitively diagnosed as MH by the calcium-induced calcium release rate (CICR) measurement test. Case presentation A 61-year-old Japanese woman with a history of stroke was hospitalized for breast cancer surgery. General anesthesia was introduced by propofol, remifentanil, and rocuronium. After intubation, anesthesia was maintained using propofol and remifentanil, and mastectomy and muscle flap reconstruction surgery was performed and completed without any major problems. After confirming her spontaneous breathing, sugammadex was administered and she was extubated. Thereafter, systemic shivering and masseter spasm appeared, and a rapid increase in body temperature (maximum: 38.9 °C) and end-tidal carbon dioxide (ETCO2) (maximum: 59 mmHg) was noted. We suspected MH and started cooling the body surface of the axilla, cervix, and body trunk, and administered chilled potassium-free fluid and dantrolene. After her body temperature dropped and her shivering improved, dantrolene administration was ended, and finally she was taken to the intensive care unit (ICU). Body cooling was continued within the target range of 36–37 °C in the ICU. No consciousness disorder, hypotension, increased serum potassium level, metabolic acidosis, or cola-colored urine was observed during her ICU stay. Subsequently, her general condition improved and she was discharged on day 12. Muscle biopsy after discharge was performed and provided a definitive diagnosis of MH. Conclusions The occurrence of MH can be life-threatening, but its frequency is very low, and genetic testing and muscle biopsy are required to confirm the diagnosis. On retrospective evaluation using the malignant hyperthermia scale, the present case was almost certainly that of a patient with MH. Prompt recognition and immediate treatment with dantrolene administration and body cooling effectively reversed a potentially fatal syndrome. This was hence a valuable case of a patient with postoperative MH that led to a confirmed diagnosis by CICR. |
| first_indexed | 2024-12-14T11:20:59Z |
| format | Article |
| id | doaj.art-73fd1cd66bb94c2fb8a28ae9a823f029 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-14T11:20:59Z |
| publishDate | 2021-04-01 |
| publisher | BMC |
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| series | Journal of Medical Case Reports |
| spelling | doaj.art-73fd1cd66bb94c2fb8a28ae9a823f0292022-12-21T23:03:46ZengBMCJournal of Medical Case Reports1752-19472021-04-011511510.1186/s13256-021-02681-0Postoperative malignant hyperthermia confirmed by calcium-induced calcium release rate after breast cancer surgery, in which prompt recognition and immediate dantrolene administration were life-saving: a case reportNatsumi Miyazaki0Takayuki Kobayashi1Takako Komiya2Toshio Okada3Yusuke Ishida4Hidekimi Fukui5Yukihiko Ogihara6Hiroyuki Uchino7Department of Anesthesia, Tokyo Medical UniversityDepartment of Anesthesia, Tokyo Medical UniversityDepartment of Plastic Surgery, Tokyo Medical UniversityDepartment of Anesthesia, Tokyo Medical UniversityDepartment of Anesthesia, Tokyo Medical UniversityDepartment of Anesthesia, Tokyo Medical UniversityDepartment of Anesthesia, Tokyo Medical UniversityDepartment of Anesthesia, Tokyo Medical UniversityAbstract Background Malignant hyperthermia (MH) is a rare genetic disease characterized by the development of very serious symptoms, and hence prompt and appropriate treatment is required. However, postoperative MH is very rare, representing only 1.9% of cases as reported in the North American Malignant Hyperthermia Registry (NAMHR). We report a rare case of a patient who developed sudden postoperative hyperthermia after mastectomy, which was definitively diagnosed as MH by the calcium-induced calcium release rate (CICR) measurement test. Case presentation A 61-year-old Japanese woman with a history of stroke was hospitalized for breast cancer surgery. General anesthesia was introduced by propofol, remifentanil, and rocuronium. After intubation, anesthesia was maintained using propofol and remifentanil, and mastectomy and muscle flap reconstruction surgery was performed and completed without any major problems. After confirming her spontaneous breathing, sugammadex was administered and she was extubated. Thereafter, systemic shivering and masseter spasm appeared, and a rapid increase in body temperature (maximum: 38.9 °C) and end-tidal carbon dioxide (ETCO2) (maximum: 59 mmHg) was noted. We suspected MH and started cooling the body surface of the axilla, cervix, and body trunk, and administered chilled potassium-free fluid and dantrolene. After her body temperature dropped and her shivering improved, dantrolene administration was ended, and finally she was taken to the intensive care unit (ICU). Body cooling was continued within the target range of 36–37 °C in the ICU. No consciousness disorder, hypotension, increased serum potassium level, metabolic acidosis, or cola-colored urine was observed during her ICU stay. Subsequently, her general condition improved and she was discharged on day 12. Muscle biopsy after discharge was performed and provided a definitive diagnosis of MH. Conclusions The occurrence of MH can be life-threatening, but its frequency is very low, and genetic testing and muscle biopsy are required to confirm the diagnosis. On retrospective evaluation using the malignant hyperthermia scale, the present case was almost certainly that of a patient with MH. Prompt recognition and immediate treatment with dantrolene administration and body cooling effectively reversed a potentially fatal syndrome. This was hence a valuable case of a patient with postoperative MH that led to a confirmed diagnosis by CICR.https://doi.org/10.1186/s13256-021-02681-0Malignant hyperthermiaPostoperative hyperthermiaCalcium-induced calcium release rate (CICR) |
| spellingShingle | Natsumi Miyazaki Takayuki Kobayashi Takako Komiya Toshio Okada Yusuke Ishida Hidekimi Fukui Yukihiko Ogihara Hiroyuki Uchino Postoperative malignant hyperthermia confirmed by calcium-induced calcium release rate after breast cancer surgery, in which prompt recognition and immediate dantrolene administration were life-saving: a case report Journal of Medical Case Reports Malignant hyperthermia Postoperative hyperthermia Calcium-induced calcium release rate (CICR) |
| title | Postoperative malignant hyperthermia confirmed by calcium-induced calcium release rate after breast cancer surgery, in which prompt recognition and immediate dantrolene administration were life-saving: a case report |
| title_full | Postoperative malignant hyperthermia confirmed by calcium-induced calcium release rate after breast cancer surgery, in which prompt recognition and immediate dantrolene administration were life-saving: a case report |
| title_fullStr | Postoperative malignant hyperthermia confirmed by calcium-induced calcium release rate after breast cancer surgery, in which prompt recognition and immediate dantrolene administration were life-saving: a case report |
| title_full_unstemmed | Postoperative malignant hyperthermia confirmed by calcium-induced calcium release rate after breast cancer surgery, in which prompt recognition and immediate dantrolene administration were life-saving: a case report |
| title_short | Postoperative malignant hyperthermia confirmed by calcium-induced calcium release rate after breast cancer surgery, in which prompt recognition and immediate dantrolene administration were life-saving: a case report |
| title_sort | postoperative malignant hyperthermia confirmed by calcium induced calcium release rate after breast cancer surgery in which prompt recognition and immediate dantrolene administration were life saving a case report |
| topic | Malignant hyperthermia Postoperative hyperthermia Calcium-induced calcium release rate (CICR) |
| url | https://doi.org/10.1186/s13256-021-02681-0 |
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